1st Session Research Articles

Longitudinal relationship between regular exercise and depression in older people: Focused on latent growth modeling

본 연구의 목적은 노인의 운동참여 특성과 우울 궤적을 추정하고, 남녀 간 노인의 운동참여 특성이 우울궤적에 미치는 영향을 검증하고자 한다. 본 연구에서는 한국고용정보원이 실시한 고령화연구패널조사(KLoSA) 1차~5차까지의 자료를 활용하였으며, 2006년 1차년도 조사 당시 65세 이상의 노인인 2,086명(남성노인: 804명, 여성노인: 1,282명)을 연구 대상으로 검증하였다. 주요 연구결과는 다음과 같다. 첫째, 무조건적 모형 검증 결과, 남녀 노인 모두 초기값과 변화율에 차이가 나타나 운동참여 특성과 우울의 궤적에 개인차가 있는 것으로 나타났다. 둘째, 노인의 운동참여 특성, 우울의 조건적 모형을 살펴본 결과, 남성 노인과 여성 노인 모두 운동 횟수, 운동 시간, 운동 기간의 초기값이 우울 초기값에 부적으로 유의미한 영향을 미치는 것으로 나타났다. 단, 남녀 노인 모두 운동 횟수와 시간, 기간의 초기값과 변화율이 우울의 변화율에는 유의미한 영향을 미치지 않는 것으로 나타났다. 본 연구 결과를 통해 남성노인과 여성노인의 운동과 우울의 관계를 종단적으로 확인하고 노인의 운동과 우울 개입에 대한 기초자료를 제공하고자 한다.The purpose of this study is to estimate the characteristics of participation in exercise and the trajectory of depressive symptoms in older people, and to verify the influence of participation in exercise among older men and women on the trajectory of depressive symptoms as well. In this study, the data gathered from the 1st through 5th sessions in the Korean Longitudinal Study of Aging(KLoSA), as conducted by Korea Employment Information Service(KEIS), were utilized. 2,086 cases who were over 65 years old at the time of the 1st year session in 2006 (804 males, and 1,282 females) were selected as the subject for verification. Major results are as follow. First, as a result of the verification of unconditional model, it was found that there are differences in both the initial score and the rate of change, indicating individual differences in the trajectory of exercise participation characteristics and depressive symptoms. Second, the result of conditional model showed that the initial score of frequency of exercise, duration of exercise, and length of regular exercise a significant negative influence to the initial score of depression in both men and women. However, it was also found that, in both senior men and women, the initial score and rate of change in the frequency of exercise, duration of exercise, and length of regular exercise do not significantly influence the rate of change of depression. Through the results of this study, the longitudinal relationship in exercise between senior men and senior women shall be confirmed, while providing fundamental data on the exercise and its intervention with depression in older people.

Long-term follow-up of circulating oxidative stress markers in patients undergoing lipoprotein apheresis by Direct Adsorption of Lipids (DALI)

ObjectiveBeyond its well-established efficacy in lowering atherogenic lipids and lipoproteins, DALI (Direct Adsorption of Lipids) apheresis has been shown to have acute anti-inflammatory and endothelium-protective effects. In the present study, we investigated long-term effects of DALI procedures on circulating oxidative stress markers. MethodsThirteen patients involved in the study underwent regular DALI apheresis for nearly two years. At sessions 1, 40 and 80 conventional lipid status and changes of systemic oxidative stress markers (oxidized LDL, anti-oxidized LDL antibodies, advanced oxidation protein products (AOPP), and myeloperoxidase (MPO)) were examined. ResultsDALI procedure efficiently reduced atherogenic lipids/lipoproteins. On day three after apheresis lipid parameters returned to pre-apheresis values. They showed no tendency to increase or to decrease over time. No significant differences were found between 1st, 40th and 80th sessions. In a similar way, levels of oxidative stress biomarkers acutely decreased after apheresis sessions and rebounded on day three after apheresis. No significant differences were observed between sessions 1, 40, and 80. ConclusionDALI apheresis repeatedly decreases atherogenic lipid/lipoprotein profile and oxidative stress biomarker levels during each session. Among all investigated parameters no longitudinal effects over two years could be observed.

<b>Electromyographic evaluation of the lower limbs of patients with Down syndrome in hippotherapy

Hippotherapy is a therapeutic method that uses the horse’s movement to achieve functional results in practitioners with Down syndrome (DS), who present motor and neurophysiological changes that affect the musculoskeletal system. Evaluating the motor behavior related to the control and the improvement of muscle activation in practitioners with Down syndrome subjected to hippotherapy. 10 practitioners were divided into two groups: Down Group (DG) – practitioners with DS, and Healthy Group (HG) – practitioners with no physical impairment. The muscles gluteus medius, tensor fasciae latae, rectus femoris, vastus medialis, vastus lateralis, biceps femoris, tibialis anterior and gastrocnemius were evaluated by electromyography using gross RMS values, which correspond to muscle activation; the evaluations were performed on the 1st and 10th hippotherapy sessions (frequency: once a week), and after 2 months interval without treatment, they were performed on the 1st and 10th hippotherapy sessions (frequency: twice a week). It was noted that activation of the studied muscles increased with the passing of sessions, regardless the weekly frequency of attendance; however, the period without treatment resulted in reduction of this effect. Practitioners with DS presented satisfactory changes in muscle activation pattern, in learning and in motor behavior during hippotherapy sessions.

Visual field changes after vitrectomy with internal limiting membrane peeling for epiretinal membrane or macular hole in glaucomatous eyes.

PurposeTo investigate visual field changes after vitrectomy for macular diseases in glaucomatous eyes.MethodsA retrospective review of 54 eyes from 54 patients with glaucoma, who underwent vitrectomy for epiretinal membrane (ERM; 42 eyes) or macular hole (MH; 12 eyes). Standard automated perimetry (Humphrey visual field 24–2 program) was performed and analyzed preoperatively and twice postoperatively (1st and 2nd sessions; 4.7 ± 2.5, 10.3 ± 3.7 months after surgery, respectively). Postoperative visual field sensitivity at each test point was compared with the preoperative value. Longitudinal changes in mean visual field sensitivity (MVFS) of the 12 test points within 10° eccentricity (center) and the remaining test points (periphery), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and ganglion cell complex (GCC) thickness, and the association of factors with changes in central or peripheral MVFS over time were analyzed using linear mixed-effects models. In addition, 45 eyes from 45 patients without glaucoma who underwent vitrectomy for epiretinal membrane (ERM; 34 eyes) or macular hole (MH; 11 eyes) were similarly examined and statistically analyzed (control group).ResultsIn glaucomatous eyes, visual field test points changed significantly and reproducibly; two points deteriorated only at the center and twelve points improved only at the periphery. Central MVFS decreased (p = 0.03), whereas peripheral MVFS increased postoperatively (p = 0.010). In the control group, no visual field test points showed deterioration, and central MVFS did not change significantly after vitrectomy. BCVA improved, GCC thickness decreased, and IOP did not change postoperatively in both groups. The linear mixed-effects models identified older age, systemic hypertension, longer axial length, and preoperative medication scores of ≥2 as risk factors for central MVFS deterioration in glaucomatous eyes.ConclusionsVisual field sensitivity within 10° eccentricity may deteriorate after vitrectomy for ERM or MH in glaucomatous eyes.

Is there influence of the load addition during treadmill training on cardiovascular parameters and gait performance in patients with stroke? A randomized clinical trial.

Although exercises involving both lower limbs are indicated for aerobic training, stroke patients have shown expressive asymmetry between the paretic and non-paretic lower limb (NPLL). Performing activities that stimulate the paretic limb during aerobic exercise may optimize training results. To evaluate if there is influence of load addition on NPLL during treadmill training on cardiovascular parameters and gait performance of subacute stroke patients. Thirty-eight stroke subjects with gait deficits were randomized into experimental group, which underwent treadmill training with a mass attached on NPLL, and control group, which underwent only treadmill training. Interventions lasted 2 weeks (9 sessions). Main outcomes were heart rate, arterial blood pressure, gait speed and distance covered. Assessments occurred at rest, 10th and 20th minutes of the session and immediately after each session. There was improvement in speed and walking distance in both groups. All cardiovascular parameters had showed no changes compared to 1st and 9th sessions and there were no differences between groups within each session. Load addition on NPLL did not alter cardiovascular parameters and gait training provide better gait performance of subacute stroke patients, which indicates this therapy can be considered useful and safe for these patients.

Performance and Physiological Improvements in Treadmill Walking after 12 Sessions of Phase Two Cardiac Rehabilitation

The benefit of cardiac rehabilitation (cardiac rehab) after a heart attack has been shown to decrease mortality and increase quality of life. PURPOSE: To determine the changes in treadmill walking time, speed and distance as well as pre- and post-exercising blood pressure (BP) and heart rate (HR) over the first 12 of 36 cardiac rehab sessions. METHODS: De-identified data from the charts of 16 post-myocardial infarction patients (13 men, 3 women; 58 ± 7 yrs, 83.8 ± 17.1 kg) who began the UNM Hospital Phase 2 cardiac rehab program between June and August of 2016 were evaluated. At intake, all patients participated in a modified Bruce protocol which was terminated when the patients reached a rating of perceived exertion (RPE) of 15 on the 6-20 Borg scale. Test results were used to prescribe patients’ respective initial walking speeds for the program. Patients walked at least twice weekly at their designated speed. Walking time and speed were adjusted regularly to keep an RPE of 13. Treadmill walking time, speed, distance, and heart rate (HR) were recorded and analyzed across the 1st, 6th, and 12th sessions through separate applications of the repeated measures ANOVA technique with post-hoc Bonferroni adjustment. The changes between pre- and post-walking bout blood pressure (BP) and HR were analyzed using individual t-tests. Statistical significance was set at p < .05. RESULTS: On average, the mean walking time (12.7, 18.6, 22.5 min), speed (2.6, 2.8, 3.1 mph) and distance (0.6, 0.9, 1.1 mi) increased with session number (p<.01). Walking distance was different between the sessions (p<.01). Walking speed differed between the 1st and 12th and between the 6th and 12th sessions (p<.03). The walking duration was different between the 1st and 6th and between the 1st and 12th sessions (p<.01). Heart rate while walking at an RPE of 13 was 104, 99, and 102 bpm for the 1st, 6th, and 12th session, respectively. Post-walking bout systolic BP was lower compared to pre-bout in the 1st and 6th session (p=.03) as was diastolic BP in the 12th session (p=.04). CONCLUSION: Patients significantly improved their treadmill walking time, speed and distance over the course of 12 Phase 2 cardiac rehab sessions. Clamping a cardiac rehab treadmill walking RPE at 13 may elicit similar improvements for Phase 2 patients resembling those in this study.

Exercise-modulated epigenetic markers and inflammatory response in COPD individuals: A pilot study

The study investigated the effects of exercise on epigenetic signals and systemic cytokine levels in chronic obstructive pulmonary disease (COPD) individuals. Ten participants of a pulmonary rehabilitation program were submitted to 24 sessions of a supervisioned exercise protocol thrice-weekly (90min/session). Blood samples were collected at baseline, after the 1st session, before and after the 24th session. A DNA hypomethylation status was observed after the 1st session when compared at baseline, while global histone H4 acetylation status was unaltered in any time-points evaluated. No significant changes were observed on cytokine levels after the 1st session. A significant enhancement on interleukin 6 (IL-6) and a decrease on transforming growth factor-beta (TGF-β) levels were found after the 24th session when compared to the pre 24th session. Moreover, 23 sessions of exercise were able to diminish significantly the basal levels of IL-6 and interleukin 8 (IL-8). These data suggest a potential role of epigenetic machinery in mediating the anti-inflammatory effects of exercise in COPD patients.

Rationale and design of theory‐based nutritional strategy to promote healthy dietary habits in severe obese adolescents: Study protocol for ICAAN (Intervention for childhood and adolescent obesity via activity and nutrition) project

BackgroundBehavioral modification on healthy eating and lifestyle is required to improve metabolically healthy status in severe obese child and adolescents. We aimed to develop tailored nutritional education programs to find barriers on dietary and lifestyle for severe obese adolescents and their caregivers.MethodsFocused on theoretical framework approaches are effective to change behavior and achieve goals. To develop four monthly contents, social cognitive theory and transtheoretical model were applied to this program. All sessions were designed to give nutritional knowledge and practical mission in a real life for individual goal setting and self‐control. In the 1st and 2nd sessions, my meal planning and portion control were emphasized based on five food groups for diet and health outcome expectations. The 3rd and 4th sessions were build up skills to choose healthy snacks and cook with fruit and vegetables. 103 participants aged 8 to 16 years will be participated in a 16 week intervention program. During the each sessions, the participants and their family will be interviewed by nutritional expert for further tailored nutritional education and counselling.ResultsEach 20‐min individual face to face nutritional education and counselling will be offered every month for the participants and their parents; monthly phone contact and txt message for social support and online food recipe to emphasize having breakfast and vegetable and fruit consumption. Following as the monthly contents, individual dietary goal setting will be attained by every participants with their family. Promoting healthy eating practices resources; an educational book, practice posters, food diaries and a water bottle will be provided to all intervention participants to motivate healthy lifestyle behaviors.DiscussionThis nutritional intervention program might be assist to implement further researches in severe obese adolescents' population.Support or Funding InformationPreparation of this article was supported by Grant 2015‐ER6401‐00 from the Division of Metabolic disease, Center for Biomedical science, Korea National Institute of Health.

The 1st Joint Session between JDDW & KDDW & TDDW

The 1st Joint Session between JDDW & KDDW & TDDW

The “PHOENIX” Space Experiment: Study of Space Radiation Impact on Cells Genetic Apparatus on Board the International Space Station

The preliminary results of the 1st session of Russian “PHOENIX” long-term space experiment are presented. The survival of dried human lymphocytes and mouse bone marrow cells in 199 days space flight is studied. The degree of DNA fragmentation is analysed for samples flown in different ISS compartments. It is shown that biological data correlates with the results of space radiation dose measurements.

Abstract 14011: Safety of Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension -Detail Analyses of Procedure Related Complications

Background: Although balloon pulmonary angioplasty (BPA) is an emerging therapeutic strategy to improve hemodynamics of patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), the original study in 2001 reported that BPA frequently induced pulmonary edema requiring mechanical ventilation. In this study, to evaluate the safety of BPA in CTEPH patients, we examined not only hemodynamics but also complications associated with latest BPA procedures by using imaging modalities. Methods and Results: From July 2009 to May 2016, we performed BPA in 78 patients with inoperable CTEPH, in whom we performed 393 sessions with combined use of imaging modalities, including optical computed tomography to select balloon size and 3D reconstructed computed tomography to determine target lesions of pulmonary arteries (PA). Mean age of the patients was 65 year-old and 65 of them were female (82%). In 72 patients (92%) who completed the treatment, hemodynamics and 5-year survival were examined after BPA. Mean follow-up period was 21 ± 15 months. After the completion of BPA treatments, mean PA pressure (38±10 to 25±7 mmHg, P&lt;0.01), pulmonary vascular resistance (7.0±3.1 to 3.7±1.7 Wood unit) and 6-min walk distance (383±156 to 489±113 meters) were all significantly improved (all P&lt;0.01). In the 393 sessions, hemoptysis was noted in 64 sessions (16%), and non-invasive positive pressure ventilation (NPPV) was used for hemoptysis and/or hypoxemia in 32 sessions (8.1%). In last 4 years, the incidence of hemoptysis and the use of NPPV have progressively decreased (Figure). Furthermore, there were no peri-procedural deaths, and 5-year survival after 1st BPA session was 94% (only one patient died for colon cancer). Conclusions: These results indicate that BPA improves hemodynamics and exercise capacity, resulting in good long-term prognosis in inoperable CTEPH patients with acceptable complication risk.

Post-weaning Environmental Enrichment, But Not Chronic Maternal Isolation, Enhanced Ethanol Intake during Periadolescence and Early Adulthood.

This study analyzed ethanol intake in male and female Wistar rats exposed to maternal separation (MS) during infancy (postnatal days 1–21, PD1–21) and environmental enrichment (EE) during adolescence (PD 21–42). Previous work revealed that MS enhances ethanol consumption during adulthood. It is still unknown if a similar effect is found during adolescence. Several studies, in turn, have revealed that EE reverses stress experiences, and reduces ethanol consumption and reinforcement; although others reported greater ethanol intake after EE. The interactive effects between these treatments upon ethanol’s effects and intake have yet to be explored. We assessed chronic ethanol intake and preference (12 two-bottle daily sessions, spread across 30 days, 1st session on PD46) in rats exposed to MS and EE. The main finding was that male – but not female – rats that had been exposed to EE consumed more ethanol than controls given standard housing, an effect that was not affected by MS. Subsequent experiments assessed several factors associated with heightened ethanol consumption in males exposed to MS and EE; namely taste aversive conditioning and hypnotic-sedative consequences of ethanol. We also measured anxiety response in the light-dark box and in the elevated plus maze tests; and exploratory patterns of novel stimuli and behaviors indicative of risk assessment and risk-taking, via a modified version of the concentric square field (CSF) test. Aversive conditioning, hypnosis and sleep time were similar in males exposed or not to EE. EE males, however, exhibited heightened exploration of novel stimuli and greater risk taking behaviors in the CSF test. It is likely that the promoting effect of EE upon ethanol intake was due to these effects upon exploratory and risk-taking behaviors.

The effect of oncology massage in the treatment and prophylaxis of patient-reported distress during cancer treatment.

191 Background: Distress (DS) levels are usually elevated across the disease course of cancer patients. Massage Therapy (MT) can improve patient-reported DS levels. We characterize the effect of MT on DS prevention and treatment, and compare the outcomes between single and multiple treatment sessions. Methods: This was a prospective single arm intervention with pre/post assessment using the validated NCCN DS Thermometer for patients on active chemotherapy who agreed to receive at least one MT session over a 10-week period. Results: 62 pts were included. 34/62 (55%) had DS when accruement started (X = 3.82, 6±4, M = 3, SD 2.32). 33/34 (97%) had improvement of DS after 1st session regardless of the type of DS on an average of 25% (p &lt; 0.05). From 1st MT session to beginning of 2nd MT session (5±3 wks), DS had improved in 78% (14/18) of pts on an average of 31% (p &lt; 0.001). 4/18 (22%) reported DS worsening chronically (X = 3.5, M = 3.5). 28/28 (100%) who had no DS reported initially did not develop it by the end of their participation. Conclusions: DS is prevalent among cancer patients and can affect treatment outcomes and overall quality of life. Regardless of type and source of DS, MT resulted in relief of patient-reported DS in a cumulative manner. MT may even appear to delay or prevent the onset of DS. Further studies are needed to determine if the improvement in DS is singularly from the MT intervention the patients received or from the emotional support that the therapist provided. A randomized study is also necessary to determine frequency and total duration of optimal treatment to confirm MT’s prophylactic and therapeutic ability for DS.

Effectiveness of massage therapy (MT) as a treatment strategy and preventive modality for chemotherapy-induced peripheral neuropathy (CIPN) symptoms.

193 Background: CIPN has a known negative impact on quality of life (QoL) and can be a dose-limiting side effect of cytotoxic drugs with no generally agreed upon therapeutic intervention. In this study MT was assessed as a primary and secondary preventive modality of CIPN symptoms under the hypothesis that it can be used as an effective prophylactic and therapeutic option. Methods: A single arm 10-week prospective study (n = 62) with pre/post intervention assessment using a validated survey instrument adapted from “Peripheral neuropathy associated with novel therapies […]”. (Clin J Onc Nur. 2008; (12)3:9-12) Results: 97% (60/62) had at least 2 CIPN-related symptoms. (Table 1) After a single MT session, at least 50% of pts (range 52-100%) reported improvement in all CIPN-related symptom categories. These observations were maintained until 2nd MT session except for vestibulocochlear related symptoms. Initially, 25/60 were on analgesics. Of these, 14 (56%) had no progression of symptoms after 1st MT session. 13/25 presented for 2nd session. 5/13 (38%) reported no progression, 4/13 (31%) reported complete resolution of symptoms and 4/13 (31%) had progression. Conclusions: With the exception of vestibulocochlear symptoms associated with CIPN, study participants reported 50% or greater improvement, which was maintained after 1st MT session. The data suggests that pts on analgesics may also benefit from MT as at least 66% (17/25) reported lack of progression or resolution of symptoms after MT intervention. Consideration for an MT-inclusive treatment strategy is supported by this study. [Table: see text]

Patient-reported benefits of massage therapy as treatment for chemotherapy-related pain.

192 Background: Massage Therapy (MT) has been suggested to provide symptom relief of chemotherapy related side effects. Its impact on pain improvement, prevention, and overall quality of life (QoL) is characterized in this study and 2 different pain scales are being compared. Methods: Patients who were on active chemotherapy and agreed to receive at least one MT session over a 10-week period were included. Wong-Baker Pain scale (WBPS) and Numerical Pain Scale (NPS) were assessed pre and post every session. Results: 62 pts were included. 25 pts were on analgesics (Opiates 64%, Gabapentin 24%, NSAIDs 12%). 34/62 pts had no complaints of pain on enrollment and only 9% (3/34) developed pain as per WBPS on subsequent visits. In 27/28 pts (97%) who had pain initially according to WBPS (0-4 scale), improvement was reported from X = 1.25 (5±5, M = 0, SD 2.31) to X = 0.32 after one MT session (4±4, M = 0, SD 1.16) (p &lt; 0.05). 25/28 pts (89%) had maintained improvement from 1st to 2nd session with an average of 50%. 11% (3/28) reported worsening of pain symptoms with an X increase average of 2.66 (3±1, M = 2). NPS was positive for 37 patients on initial visit. NPS revealed a similar trend with pre-massage X of pain from 2.76 (5±5, M = 2, SD 2.87) to 1.18 (4±4, M = 0, SD 2.01) after 1st session (39.5% improvement) (p &lt; 0.05). 18/25 (72%) saw a decrease in pain level per NPS (X = 2.27) between each session, whereas 28% noted worsening of pain by the end of their participation. Conclusions: MT is a high-value, low-risk intervention for reducing cancer pain and cancer treatment-related pain. MT could be used to address patients' need for emotional and physical human connection at a time when their quality of life is fragile. MT may offer pain prophylaxis when provided in a cumulative manner. NPS appears to be more sensitive than WBPS for pain screening in oncologic patients. Further studies are necessary to confirm the suggested findings of massage therapy for pain prevention and treatment.

Use of Multi-Intake Temporal Dominance of Sensations (TDS) to Evaluate the Influence of Cheese on Wine Perception.

Though the gastronomic sector recommends certain wine-cheese associations, there is little sensory evidence on how cheese influences the perception of wine. It was the aim of this study to dynamically characterize 4 wines as they would be perceived when consumed with and without cheese. The tasting protocol was based on multi-intake temporal dominance of sensations (TDS) coupled with hedonic rating. In the 1st session, 31 French wine and cheese consumers evaluated the wines (Pacherenc, Sancerre, Bourgogne, and Madiran) over 3 consecutive sips. In the following sessions, they performed the same task, but eating small portions of cheese (Epoisses, Comté, Roquefort, Crottin de Chavignol) between sips. All cheeses were tasted with all wines over 4 sessions. TDS data were mainly analyzed in terms of each attribute's duration of dominance by analysis of variance, multivariate analysis of variance, and canonical variate analysis. Results showed that cheese consumption had an impact (P < 0.1) on dominance duration of attributes and on preference for most wines. For example, in Madiran, all cheeses reduced dominance duration (P < 0.01) of astringency and sourness and increased duration of red fruit aroma. Although the number of consumers was small to make extended general conclusions on wine's preference, significant changes were observed before and after cheese intake.

PP.09.05] HEMODIALYSIS IMPROVES RIGHT VENTRICULAR SIZING AND REDUCES PULMONARY CIRCULATION LOADING IN PATIENTS WITH END-STAGE RENAL DISEASE

Objective: The effect of acute pre-load reduction during hemodialysis on right ventricular (RV) function is not well understood. Accordingly, the aim of this study was to evaluate acute changes in novel echocardiographic and tissue Doppler-derived indices of RV function during the first and second weekly dialysis sessions. Design and method: A total of 41 adult patients receiving standard thrice-weekly hemodialysis for at least 3 months participated in this study. Two-dimensional echocardiographic and tissue-Doppler imaging studies were performed with a standard cardiac ultrasound device (Vivid 7, GE, Horten, Norway) shortly before and after the first and second weekly dialysis sessions. Results: Significant reductions from pre- to post dialysis were noted in body weight (1st session: 72.2 ± 12.6 vs 69.3 ± 12.5 kg, p < 0.001; 2nd session: 71.5 ± 12.7 vs 68.9 ± 12.5 kg, p < 0.001) and in systolic BP (1st session: 145.5 ± 21.6 vs 135.9 ± 23.5 mmHg, P < 0.05; 2nd session: 143.1 ± 19.8 vs 135.2 ± 20.4 mmHg, P < 0.05). RV end-diastolic diameter (1st session: 3.47 ± 0.97 vs 3.09 ± 0.83 cm, P < 0.001; 2nd session: 3.40 ± 0.83 vs 3.10 ± 0.88 cm, P < 0.001) and right atrial volume index (1st session: 27.33 ± 10.65 vs 21.30 ± 10.16 cm, P < 0.001; 2nd sessions: 27.83 ± 13.94 vs 23.04 ± 13.19 cm, P < 0.001) were reduced between the start and end of both sessions studied. Similarly, significant intradialytic reductions in inferior-vena-cava diameter were evident during both dialysis sessions (1st session: 1.93 ± 0.41 vs 1.54 ± 0.45 cm, P < 0.001; 2nd sessions: 1.76 ± 0.40 vs 1.37 ± 0.40 cm, P < 0.001). Acute pre-load reduction was accompanied by improvement in RV systolic pressure (1st session: 44.64 ± 16.25 vs 33.14 ± 12.43 mmHg, P < 0.001; 2nd session: 37.72 ± 14.46 vs 30.48 ± 13.36 mmHg, p < 0.001) and in tricuspid regurgitation maximum velocity (TRVmax) (1st session: 2.86 ± 0.54 vs 2.53 ± 0.54, cm/sec, P < 0.001; 2nd session: 2.68 ± 0.55 vs 2.46 ± 0.54 cm/sec, P < 0.001). Indices reflecting RV diastolic function remained unchanged from pre- to postdialysis in both sessions. RV systolic function assessed by peak systolic RV velocity (Sm-RV) remained stable in both occasions (1st session: 0.15 ± 0.04 vs 0.15 ± 0.04, m/sec P = 0.575; 2nd session 0.14 ± 0.03 vs 0.15 ± 0.04 m/sec; P = 0.149). Conclusions: This study shows that pre-load reduction during hemodialysis improves RV sizing parameters and reduces pulmonary circulation loading, without affecting the systolic and diastolic performance of right ventricle.

PP.09.09] EFFECT OF HEMODIALYSIS ON NOVEL ECHOCARDIOGRAPHIC AND TISSUE DOPPLER-DERIVED INDICES OF LEFT VENTRICULAR FUNCTION IN END-STAGE RENAL DISEASE PATIENTS

Objective: Left ventricular (LV) systolic and diastolic dysfunction is common and contributes to the increased cardiovascular morbidity and mortality in end-stage-renal-disease (ESRD). Hemodynamic alterations and shifts in volume status during hemodialysis acutely affect LV sizing and function. However, the effect of hemodialysis on novel, less volume-dependent, tissue Doppler-derived indices is not fully understood. This study evaluated acute changes in novel echocardiographic and tissue Doppler-derived indices of LV dysfunction during the first and mid-week dialysis session. Design and method: Forty-one stable ESRD patients receiving thrice-weekly hemodialysis for at least 3 months underwent 2-dimensional echocardiographic and tissue-Doppler imaging evaluation with a Vivid 7 cardiac ultrasound device. Echocardiographic studies were performed shortly before and after the first and second weekly dialysis sessions. Results: Body weight (1st session: 72.2 ± 12.6 vs 69.3 ± 12.5 kg, p < 0.001; 2nd session: 71.5 ± 12.7 vs 68.9 ± 12.5 kg, p < 0.001) and systolic blood pressure (1st session: 145.5 ± 21.6 vs 135.9 ± 23.5 mmHg, P < 0.05; 2nd session: 143.1 ± 19.8 vs 135.2 ± 20.4 mmHg, P < 0.05) were reduced during both dialysis sessions. Significant reductions in left atrial volume, LV end-systolic and end-diastolic volume were noted from pre-to post-dialysis in both sessions studied. LV systolic function assessed by LV ejection fraction, stroke volume and cardiac output, remained unchanged from pre- to postdialysis. In contrast, peak early (E) and the ratio of peak early to late mitral inflow velocity (E/A) were significantly decreased during both sessions (1st session: 1.15 ± 0.48 vs 0.92 ± 0.49, p = 0.001; 2nd session: 1.18 ± 0.48 vs 0.86 ± 0.48, p < 0.001). Peak tissue velocity around the mitral annulus during early diastole (mean Em) was significantly decreased during the 1st weekly session, but not during the mid-week dialysis (1st session: 0.188 ± 0.03 vs 0.167 ± 0.03 cm/s, p < 0.001; 2nd session: 0.188 ± 0.04 vs 0.179 ± 0.05 cm/s, p = 0.366). Mean isovolumetric relaxation time was stable in both occasions. Conclusions: This study shows that hemodialysis improves LV sizing and reduces LV filling pressures during diastole. This effect seems to be more prominent during the first weekly dialysis session. Additional research efforts are warranted to fully elucidate whether these acute intradialytic alterations translate into long-term deterioration of cardiac function.

Psychophysiological Responses to Repeated-Sprint Training in Normobaric Hypoxia and Normoxia.

To compare psychophysiological responses to 6 repeated-sprint sessions in normobaric hypoxia (RSH) and normoxia (RSN) in team-sport athletes during a 2-wk "live high-train low" training camp. While residing under normobaric hypoxia (≥14 h/d, FiO2 14.5-14.2%), 23 lowland elite field hockey players performed, in addition to their usual training, 6 sessions (4 × 5 × 5-s maximal sprints, 25-s passive recovery, 5 min rest) under either RSH (FiO2 ~14.5%) or RSN (FiO2 21%). Sprint 1 and 5 times, physiological strain (heart rate [HR], arterial oxyhemoglobin saturation [SpO2]), and perceptual responses (overall peripheral discomfort, difficulty breathing, and lower-limb discomfort) were monitored. During the 1st session, HR increased across sets (P < .001) independently of the conditions, while SpO2 was globally lower (P < .001) for RSH (averaged value: 91.9% ± 1.2%) vs RSN (96.9% ± 0.6%). Thereafter, SpO2 and HR remained similar across sessions for each condition. While 1st-sprint time remained similar, last-sprint time and fatigue index significantly decreased across sets (P < .01) and sessions (P < .05) but not between conditions. Ratings of overall perceived discomfort, difficulty breathing, and lower-limb discomfort were higher (P < .05) in RSH vs RSN at the 1st session. During subsequent sessions, values for overall perceived discomfort (time [P < .001] and condition [P < .05] effects), difficulty breathing (time effect; P < .001), and lower-limb discomfort (condition [P < .001] and interaction [P < .05] effects) decreased to a larger extent in RSH vs RSN. Despite higher hypoxia-induced physiological and perceptual strain during the 1st session, perceptual responses improved thereafter in RSH so as not to differ from RSN. This indicates an effective acclimation and tolerance to this innovative training.

Virtual reality applied to the lower limb motor function in post-stroke individuals

Strokes can generate significant motor, tonic and sensitive changes. Virtual reality (RV), focused on rehabilitation, can bring several benefits such as improvements on physical fitness, motor skills and balance. Objective: To assess the effects of the RV intervention to the static and dynamic balance, weight load on the affected limb, tone and muscle recruitment, functional independence and sensorimotor function in post-stroke individuals. Methods: Quasi-experimental and prospective clinical study with 6 subjects with diagnosis of stroke. Before and after the intervention with Nintendo Wii Fit Plus, the subjects were assessed by the Berg Balance Scale, Timed “Up and Go” and Dynamic Floor Index; Gait Test (GT); Modified Ashworth Scale (MAS); Electromyography; Barthel Index and Fugl-Meyer Scale (FMS). The Statistical analysis used Kolmogorov-Smirnov test, t test and Wilcoxon. Results: The 1st and 15th session evaluations have shown that GT (p = 0.03, d = 1.96, P = 96%), MAS for hip extensor muscles (p = 0.04; d = 3.77; P = 99%), knee extensors (p = 0.04; d = 3.23; P = 99%), plantar flexors (p = 0.01; d = 3.18; P = 99%), FMS in coordination/velocity dimensions (p = 0.02; d = 6.74; P = 100%) and sensitivity (p = 0.01) presented significant results, large effect size and power above 90%. Significant values were not found to the other evaluations. Conclusion: The RV rehabilitation program was effective and improved the weight-load in affected limb, muscle tone and sensorimotor function of the subjects